medical diets and nutrition support

includes nutritional screening and assessment from lecture 1 material and all lecture 3 material

nutritional screening

checklist of factors that increase risk of nutritional problems and morbidities that can lead to a prolonged stay or vulnerability to infections

must be performed within 24 hours of admission

nutrition screening tools

malnutrition screening tool, mini nutritional assessment short form, pediatric nutrition screening tool

5 components of nutrition assessment

diet history, physical assessment, anthropometrics, biochemical data, nutrient requirements

diet history

24 hour recall, 3/7 day diary, food frequency questionnaire

nutrition focused physical exam skin hair nails

eval for micronutrient deficiencies, dehydration

nutrition focused physical exam eyes, mouth

eval for micronutrient deficiencies, dehydration

nutrition focused physical exam tricep/bicep/temporalis

eval for muscle loss/wasting

nutrition focused physical exam clavicle, rib, iliac crest

eval for protruding or prominent bones which could suggest fat loss

nutrition focused physical exam extremities

eval for pitting edema, thin, or no muscle

nutrition focused physical exam hand grip strength

eval for muscle function which could suggest reduced nutritional status

anthropometrics in pediatrics

weight, recumbent length or standing height, head circumference

anthropometrics adults

BMI is gold standard, wait circumference, wait to hip ratio, skin fold thickness, bioelectrical impedance analysis

BMI cons

does not account for amount of body fat vs muscle, not inclusive of racial/ethnic groups

biochemical data

BMP, CBC, CRP, A1C, lipid panel, ferritin/iron studies, zinc, vit B12, folate, thiamine, retinol, 25 (OH)D, ascorbic acid

basal energy expenditure

amount of energy required to maintain body’s normal metabolic activity based on age, weight, height

thermal effect of food

amount of energy expended during and following ingestion of food, approx 10% BEE

nutritional requirement calorimetry equations for critically ill patients

mifflin-st. jeor, penn state, harris-benedict, schofield equations

FAO/WHO/UNU equations for peds

calories for critically ill patients

22-35 kcal/kg

protein needs in critically ill patients

1-2.5 g/kg

medical (therapeutic)diet

meal plan that controls the intake of certain foods/nutrients

part of treatment of a medical condition

prescribed by a medical provider and planned by a registered dietitian

medical nutrition therapy

form of treatment using nutrition education and behavioral counseling to prevent or manage a medical condition

prescribed by a medical provider and carried out by a registered dietitian

components of medical nutrition therapy

assessment, nutritional diagnosis, interventions, monitoring with follow up

type I DM

autoimmune destruction of pancreatic beta cells resulting in complete insulin deficiency

type II DM

complex disorder characterized by a relative insulin deficiency resulting from a combo of longstanding insulin resistance and eventually inadequate insulin production to overcome persistent insulin resistance

glucose homeostasis

balance between glucose intake, glucose uptake and utilization by peripheral tissues, and glucose storage in the liver

glycemic response depends on…

quality and quantity of carbohydrates and overall macronutrient composition

referral to medical nutrition therapy

all diagnosed T1D and T2D

glycemic index

measures relative impact of carb containing foods on BG determined by incremental rise in BF after ingestion

glycemic load

product of glycemic index value of a food and its total carb content

BG response influenced by quality and quantity of carbs

consistent carb diet

pts prescribed a specific amount of carbs per day based on nutritional assessment and needs

diabetes plate method

½ non-starchy vegetables, ¼ carbs, ¼ protein

T1D insulin therapy

prandial/bolus insulin therapy to mimic physiologic insulin release

ICR

insulin to carbohydrate ratio, grams of carbs covered by 1 unit of insulin

hyopglycemia causes

not eating, exercise, alcohol consumption

hypoglycemia symptoms

dizziness, diaphoresis, tremors, hunger, confusion, syncope, seizures

level 1 hypoglycemia

from 54-70 mg/dL

level 1 hypoglycemia treatment

repeat check and avoid critical tasks

ingest carbs

level 2 hypoglycemia

<54 mg/dL

level 2 hypoglycemia treatment

ingest 15-20g fast acting carb and retest in 15 min

level 3 hypoglycemia

severely altered, require assistance

level 3 hypoglycemia treatment

with IV access - 25g D50

without IV access - glucagon SQ, IM, nasal

stroke

acute focal neurological deficit attributed to vascular injury which may manifest as an infarction from ischemia or hemorrhage within the CNS

types of stroke

ischemic (85%), hemorrhagic (15%)

stroke and HTN recommended dietary patterns

DASH and mediterranean diets